ADHD Explained

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Hello and welcome to Ripples of Resilience, a podcast from Jana Marie Foundation, where we explore ideas, tools, and conversations that support mental health, resilience, and well-being for young people and the adults who care about them.
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I'm your host, Marisa Vicere.
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Today we're diving into a topic that comes up often in conversations with parents, educators, and students, ADHD.
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What is it really?
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How does it show up in kids and teens today?
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And how can we better support those navigating it?
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To help unpack this, I'm joined by our resident expert, Dr.
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Peter Montminy.
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Welcome.
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Yeah, thank you, Marisa.
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Really glad to be here.
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Love working with kids with ADHD.
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Maybe because I are one too, but I'm looking forward to this one today.
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Thank you so much, and we're so grateful that you share all of your insights with us and for all your work that you do at A Mindful Village.
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Oh, thank you.
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So let's start with the basics.
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ADHD is a term we hear all the time, but what does it really mean?
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Yeah, so ADHD technically stands for attention deficit hyperactivity disorder.
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It's a neural developmental condition.
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It's really a neurological developmental disability, a hardwiring difficulty in the part of the brain that manages attention, the executive function part of the brain in particular, that manages your ability to pay attention, selectively attend to things that are most relevant and not be distracted by irrelevant or unimportant things, sustained attention, especially when it's boring to you.
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Can you sustain your attention and effort on things?
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Can you plan a response before, right?
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Stop and think before you act, the opposite of impulsive.
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Can you plan a response?
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Can you get going on that work?
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And can you self-monitor and self-correct effectively and really manage and control your attention, your emotions, and your impulses?
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And the part of the brain, the prefrontal cortex that's responsible for doing those things doesn't work quite as well for kids who have ADHD or adults who have ADHD as it does for others.
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All the other parts of their brain, they can be very smart, they can be creative, they can be all these other things, as we'll talk about.
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It just means sustaining attention and inhibiting impulses is a little harder for them than others.
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Thank you.
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And it's not just about being quote unquote hyper or even easily distracted, but really it's more so about the wiring of the brain.
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That's right.
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ADHD is something that is diagnosable.
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So what are some ways that this shows up in children and teens?
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Yeah, so if we think again about a whole range of individual differences in humans, and we think some of us may be more or less able to do this or that characteristic, or uh and and those differences exist in all of us, and then at some point those differences become difficulties, and at some point they impair functioning, become disorders.
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So here's my favorite.
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I invented this years ago, it's integrated from research.
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See what you think.
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I say to parents and kids that I work with, I say, tell me, so let's say we're talking uh to a parent.
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See, I'm gonna describe a human characteristic, and I want you to tell me if you think your child is low, medium, or high, and maybe very low or very high, or somewhere in between on this you know range of human dimensions here.
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So here's the here's the dimension, ready?
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The ability to sustain your attention and effort on dull, tedious tasks that aren't intrinsically interesting to you consistently and independently.
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The ability to sustain your attention and effort on dull, tedious tasks that don't interest you consistently and independently.
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And nine times out of ten, that's the first question I'm asking in an assessment for ADHD, and we have lots of formal ways to look at it, but I start out there, and nine times out of ten, the parents immediately go, Oh, very low.
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You just described what my kid is absolutely not good at doing.
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And they go, We got a good chance we're dealing with ADHD here.
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Now we have to rule out some other things, but uh that's the way I often think about it.
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More specifically and technically, there are three subtypes of diagnosable ADHD currently, and research is always changing, and over time this may evolve.
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But currently we have ADHD inattentive type, impulsive hyperactive type, or combined.
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The inattentive type is the is the very distractable, maybe even daydreamy, you know, tuning in and out, can't sustaining attention is clearly the harder part.
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For the impulsive ones, those are the kids who may be more hyperactive, especially when they're young, restless and internally impulsive even when they're older.
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And of course, combined, which is often the most uh prevalent type, is the combination of the two.
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Thank you so much.
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And we've talked about this before on various episodes, but it can manifest differently or look differently depending on the individual.
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Sure.
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We have these common characteristics, but it absolutely can look different, especially developmentally, right?
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Uh being impulsive and hyper and distracted, you could say, is a definition of early childhood, not ADHD, right?
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So we have to say relative to age norms and standards, are they more impulsive, more distractible compared to others?
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There are a little bit of gender differences here.
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Often it's uh underdiagnosed in girls because they don't display the outward impulsive restlessness part quite as much, uh, but that's being corrected over time.
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Um and uh we do see this across ethnic origins, across countries.
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The the rate with rigorous adhering to the criteria and an effective evaluation for ADHD, we're looking at five to seven percent of the population across ethnicities, races, and and cultures across the globe typically.
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So that's kind of standard.
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But it can look different.
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I'm gonna come back to especially age-wise.
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Younger children might be more physically active on the outside, as we've already mentioned.
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Whereas in the teen years, they say, Well, my kid's not hyperactive, they're not running around.
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No, but they might be subtly fidgeting or often bouncing their leg or tapping their fingers, or more so, they may have an internal sense of restlessness and agitation and fidgetiness, even if they've learned to kind of contain it on the outside.
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So there's some subtle differences there that we look at sometimes.
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And I think there's still a lot of misunderstanding around the disorder.
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So, can you share a little more about some of the different myths that might be out there or misunderstandings that there are?
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Yeah, well, one of the biggest ones is my kid can't have ADHD because they can play Legos or their favorite video game for hours on end.
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So I know they don't have a problem paying attention.
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Bam, wrong answer.
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Not true.
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Remember my general working definition.
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It's the difficulty sustaining your attention on things that don't interest you.
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So very often we do have kids, again, or adults, who may have this condition who can do just fine if it's really motivating, interesting, exciting to them, they're dialed in.
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But if it's boring or laborious or hard, then it's harder to sustain again that attention and effort to get to a future goal, a future payoff that's further away from them.
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That's really what's harder for them.
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Uh, so we need to understand that.
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Sometimes people are worried, you know, as well, they're kids running around because there's, you know, their parents aren't controlling them better, and then it's you know the poor parenting excuse.
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And that's not true at all again.
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Um, ADHD is a neurological condition.
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There's lots of very strong genetic loading, andor some early environmental insults or injuries.
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It's very biologically determined primarily.
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Now, of course, parenting and caregiving can aggravate or amplify the condition and make it worse, or it can mitigate it or reduce it and make it better.
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So we absolutely have parenting and teacher tips and tools for how to help a kid manage it and limit the negative effects, but it's not caused by our caregiving.
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Does that make sense?
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It absolutely does.
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All right.
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And then a third one, a common myth or misunderstanding, is that the kids will grow out of it.
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And again, the idea, this is a neurological condition that is never really likely cured or grown out of, but needs to and can be managed quite well.
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A little footnote to that is that sometimes it does seem to disappear or be less of a problem in adulthood.
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And that's because only in our public schools growing up K to 12 are you supposed to be sitting quiet and still all day long and focusing on a certain type of learning and a certain type of behavior.
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And oh, by the way, be a jack of all trades and learn to be good at all your different subjects, be interested in and good at all your subjects equally.
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And then you graduate from high school and maybe from college, and that's not how the world works.
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You self-select into areas, occupations, and careers where you have your strengths and where your weaknesses, like maybe you know, paying attention to, you know, being an accountant for someone with ADHD maybe isn't a good idea because your attention to detail across dry, for some people, boring numbers all day long and technicalities might not suit you.
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But you self-select into a career that where, you know, that's not a liability for you.
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And ideally, you have then a working partner and administrative assistant who covers some of your weaknesses.
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Ideally, you marry a partner who complements your weaknesses and they can take care of that detailed stuff or the more mundane stuff that isn't your strength, um, and because it may be a strength of theirs.
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Yeah.
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So often it kind of ideally it becomes less um impairing as you grow up because you learn where and how to manage it better and play to your strengths.
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Does that make sense?
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It absolutely does.
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And I think you hit on a key part, which is around our student experience.
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You know, schools aren't necessarily designed for the kids that aren't neurotypical.
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Exactly.
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That word was in my mind.
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Um, it's hard to sit all day.
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I know, even as an adult, I can't sit for more than like a half hour at a time where I'm not trying to get up and walk and move around.
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And it's hard to pay attention to those things that you don't love.
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And we're asking our kids to do it, um, depending on what their schedule setup is like, oftentimes in block scheduling for an hour and a half to be fully alert and paying attention, which is a lot of time.
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And so, how does ADHD impact a student's experience?
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Yeah, as we both said now, school are typical types of schools uh nowadays can be especially challenging because students struggle with organization, completing assignments, uh uh being still and quiet to the degree being asked for, and often then get wind up being mislabeled as lazy or unmotivated or careless or reckless, which couldn't be farther from the truth.
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For these kids, it's not a matter of knowing what to do, it's not a matter of caring what to do, it's a matter of struggling of doing what you know you're supposed to be doing and that you care about.
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The breakdown is at the point of performance, it's inhibiting those other urges, um, those competing urges.
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And so, yes, our typical uh school structure combined with neuro atypical or neurodiverse uh brains, sometimes bigger challenge for kiddo and for parent and for teachers.
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So we want to come together and say, all right, this is what we're dealing with, let's deal with it more effectively for all our sakes.
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So important.
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And so that really brings us to accommodations.
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So for parents who may have a student who has been diagnosed with ADHD, what can they ask for help with from the schools in terms of accommodations?
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Sure.
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And again, if we think about a range of differences to difficulties to disorders, basically a range of severity here that we may be thinking about.
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On the milder end, you just kind of match up and do a few minor common sense adjustments for teacher and student, and you get a teacher who's understanding, empathic, clear with expectations, consistent with expectations, and warm and empathic when you're struggling to meet those.
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That's the ideal teacher for, I would say, any kid, and it's definitely the ideal teacher, the necessary teacher for kids with ADHD, right?
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Um, so we might just not need to formally do anything other than make some minor adjustments or really match kids up with a teacher who's going to roll with it in a good supportive way.
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Uh, but then if we're having more difficulties showing up, we can go to a 504 section 504 from IDEA service agreement where you make some minor, more formal accommodations that get coded in and can follow the child across teacher to teacher, grade to grade.
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And I'll give you some examples of those in just a minute.
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Or if there's a significant disorder that's impairing their school functioning significantly and keeping them from making educational progress they would make otherwise, they might qualify for bigger, fuller supports, including an IEP or individualized education plan.
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So just like there's a range of severity of your ADHD symptoms, there's a range of supports out there.
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Now, at their core, if I can take another minute, practically what things might do at any of those levels, uh preferential seating, like sitting near the teacher or away from distractions, especially you know, the door or the window or the distracting peers or socially.
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And again, you don't just do this to the child, you do this with the child.
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You say, Hey, have you noticed you tend to get more distracted when you're over here around your buddies?
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And maybe this class will be easier for you if we kind of do this.
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Let's try it and see, right?
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We're trying to do a constructive how can you get through this thing smarter and easier for you.
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We might look at extended time on tests or assignments.
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Now, this is a global one that often gets written into 504s and IEPs, and I have a bone to pick with it because you just open-ended is cookie cutter plate, I saw it online, extended time.
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My kid, well, do they really need extended time?
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I asked the kids, how often do you typically finish the test in the allotted time?
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Well, yeah, pretty much most of the time, you know.
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And for kids who do that, then they don't automatically need it.
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For kids, some kids say, no, I I sweat it, I never get through it, I only get about three-quarters of the way through it.
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Then let's think what type of extra time do they need?
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Have it be specific to that student, have it be time limited, um, and maybe it's specific to certain subjects more than others.
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So we want to be mindful of any of these accommodations, that it's not just off the rack, it's tailored to fit and make sense, yeah.
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Um, so other common ones that you want to uh again fine-tune or tailor to fit this kiddo in the situation, breaking larger assignments into smaller, more manageable steps, what we call chunking, plain and simple.
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And chunking for ADHD kids is really, really important.
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It's putting up clearer, many expectations with many cues and reminders, and then many more immediate payoffs or reinforcers.
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What these kids need is more frequent cues and consequences, and the challenge is to keep them positive, consistent and positive.
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So that's the practical.
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But they need those guardrails because they're going to bounce off them more than another kid.
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Um, uh, providing uh instructions for tasks in different modalities, verbally saying it, writing it down, picture maps, visual cues and reminders, using a range of different external cues when you can't always be there to remind them.
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Very helpful.
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Using check-ins for understanding and organization, brief little check-ins, organizers, um, and save the best for last, the most important one, movement, right?
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You just mentioned hard for you to sit still for a half an hour and even record these sessions without wanting to, you know, get up and need to move, and and you're very creative, right?
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And that's an asset.
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But you know, all right, sustain kind of attention, sitting still, maybe not always easy.
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So movement is really the number one thing.
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All the recent brain and learning and emotional mental health conferences I've been to for the last handful of years, the number one takeaway I come back from my CE conferences is for mental health in general and ADHD in particular, we need to be moving.
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The best thing you can do for your brain and your mind is move the body.
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So the idea of sitting still quietly for six hours is just goofy.
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And we need to create movement breaks, we need to create non-disruptive movement options for that kid with ADHD in the classroom and really get the body moving and engaged to help their mind come back and be focused.
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All right, there's that's a mouthful, but there's a bunch of things we can try.
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And that is amazing to have those concrete examples to really start those conversations if you're noticing those symptoms and some things that could be helpful for your kiddo.
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Yeah.
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So I know we've talked about technology recently, and this seems to be a good place to bring it up again.
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Today's environment is very fast paced.
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We are connected 24-7.
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We have busy schedules, there's constant stimulation.
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So, how does this impact kids with ADHD?
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Well, it is making all of us collectively move more towards the ADHD end of that continuum or spectrum.
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It just is.
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Attention spans are shorter, the idea of immediate gratification, immediate results, 24-7 stimulation coming at you, it is conditioning all our brains to move in the direction of shorter attention spans.
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And yet, competent performance at your job, solving complex problems in your family, caregiving, raising children requires pause, breathe, reflection, not right, more reflection and response rather than just immediate impulsive reacting.
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We've talked about that in different ways over time as well.
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So it's this uh this challenge of we need more sustained attention, but it's completely pulling us in the opposite direction, and there's increasing competing demands for our attention.
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The notifications, social media, etc., make it harder for all of us, and it double whammies on the kids with ADHD.
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So we need to figure out how to do that.
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They're getting the quick payoffs on their phone more than they're getting quick payoffs in the natural environment.
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We need to counterweight that with growing their capacity to slowly build your attention span, your focus and effort span, and your ability to delay gratification to get a delayed payoff because ultimately in the grown-up world, you still are gonna need more of that.
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So it's a real challenge.
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That sounds like it.
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I think one of the important parts of this conversation is recognizing strengths.
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Right.
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So this isn't necessarily a deficit, it's just something to be aware of.
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Absolutely.
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One of my favorite books, paperback book I've been hawking for many, many years now, The Gifts of ADHD.
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It's small, fully digestible.
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Get it for yourself, your kiddo, if you're struggling with kind of feeling down that you have an ADHD difficulty.
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Um, but in the the short of long short of it is uh individuals with ADHD are incredibly creative, often energetic, very curious, capable of thinking outside of the box.
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Lots of things we want on our team at work or our team at school or in our families.
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It just needs to be harnessed at times, you know.
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There's a time to be uh putting that in the foreground.
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They often bring a level of passion and innovation that can be a real asset, especially right when they're in environments that recognize it as having a gift side, appreciate it and support it, and especially support how they may learn, process, and produce information differently.
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So if we can really leave room for all the colors of the rainbow at the table, in the classroom, in the work group, right, in the family.
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And I'll just say individuals with ADHD can be a whole lot of fun.
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Absolutely.
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And so you've mentioned that support, and we talked about it within a school setting.
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Um, but our kids aren't just at schools, our teens aren't just at schools.
00:21:36.079 --> 00:21:43.680
Um, so what else can we do as parents or as community members to further support somebody who has a diagnosis of ADHD?
00:21:43.920 --> 00:21:44.400
Yeah.
00:21:44.400 --> 00:21:47.839
I often like to zoom out before zooming back in.
00:21:47.839 --> 00:21:53.200
So my zoom out thoughts on this, and then we'll zoom back into more practical, concrete things.
00:21:53.200 --> 00:21:59.759
We're zooming out and we're reminding ourselves and our kiddos hey, everybody has strengths and struggles, true or false?
00:21:59.759 --> 00:22:02.000
I literally just write, I put that out.
00:22:02.000 --> 00:22:05.039
I say it to you, I say it to a kid, I say it to a parent teacher.
00:22:05.039 --> 00:22:12.559
And when we recognize the universal truth of that, like duh, well, okay, now let's start zooming back in and apply it more.
00:22:12.559 --> 00:22:15.759
You are more than the ADHD condition.
00:22:15.759 --> 00:22:28.960
That's a small part of your brain, and you have all these other parts of your brain that are working, and the small part of your brain, your brain is a small part of who you are, your whole body, your relationships, your interests, your you you so let's put it in perspective.
00:22:28.960 --> 00:22:33.200
You have all these strengths and you have some struggles, and some of your struggles are ADHD.
00:22:33.200 --> 00:22:36.240
By the way, some of your struggles are other things too, right?
00:22:36.240 --> 00:22:43.920
In other words, the idea is don't let it define you, but have it be a small slice of the pie chart of who you are.
00:22:43.920 --> 00:22:46.079
So I remind kids of that.
00:22:46.079 --> 00:22:50.400
And then even the ADHD slice of the pie, as we just said, has strengths.
00:22:50.400 --> 00:22:55.680
There's times when your ADHD is an asset, and there's times when it's a liability.
00:22:55.680 --> 00:23:00.799
So let's get real about when do you notice that it's working for you more?
00:23:00.799 --> 00:23:02.720
When do you notice it's working against you more?
00:23:02.720 --> 00:23:06.319
When do you notice it's easier for you to get work done and be successful?
00:23:06.319 --> 00:23:08.160
When do you notice it's harder?
00:23:08.160 --> 00:23:13.200
And to just get real and practical with kids and join together in thinking that way.
00:23:13.200 --> 00:23:27.920
So I think that's the most important support thing we can do is help them have a realistic recognition of their strengths and struggles and how they when they show up more one way or another and what things they want to do differently to handle it.
00:23:27.920 --> 00:23:29.759
Alright, what else can help them?
00:23:29.759 --> 00:23:43.519
Clearly, we've mentioned a few times again, consistency is important for all child rearing, and it's more important for kids who, by definition, are going to be inconsistent with their ability to regulate their attention and their impulses.
00:23:43.519 --> 00:23:53.599
So we need to be external guardrails and more consistent and clear than ever with those routines and breaking those tasks into small manageable steps, as we've said.
00:23:53.599 --> 00:23:56.319
Also focusing on skill building, right?
00:23:56.319 --> 00:23:59.920
Like time management, organization, emotion regulation.
00:23:59.920 --> 00:24:12.400
Rather than just correcting the behavior and applying consequences, we're always working from the outside in on the behavior and the inside out with the child and their thoughts and feelings and coaching them up on how to do that.
00:24:12.400 --> 00:24:15.039
And as always, connection matters.
00:24:15.039 --> 00:24:25.920
Kids do better when they feel like they're in the context of a caring relationship, that they're seen and understood, then they're going to be able to access those strengths better.
00:24:26.480 --> 00:24:27.599
Thank you so much.
00:24:27.599 --> 00:24:32.240
And I know you talked about some specific strategies that tend to work well in schools.
00:24:32.240 --> 00:24:35.519
Are there ones that can carry over into the home life as well?
00:24:35.839 --> 00:24:36.079
Yeah.
00:24:36.079 --> 00:24:38.720
Visual cues are really helpful.
00:24:38.720 --> 00:24:46.000
Uh, picture maps of steps, things to do, visual schedules, reminders, timers.
00:24:46.000 --> 00:24:48.559
I mentioned time management a minute ago.
00:24:48.559 --> 00:24:50.160
I'm going to take an extra minute.
00:24:50.160 --> 00:24:53.039
A really helpful way, borrowed from Dr.
00:24:53.039 --> 00:25:03.119
Russell Barkley, of thinking about ADHD is that you could call it a condition of temporal nearsightedness.
00:25:03.119 --> 00:25:05.200
Now check this out for a minute.
00:25:05.200 --> 00:25:08.559
If you are visually nearsighted, what does it mean?
00:25:08.559 --> 00:25:16.960
You can see things that are close in space to you, but you can't see things that are far away in space to you.
00:25:16.960 --> 00:25:21.680
You have trouble seeing the board if you're sitting in the back of the classroom, the whiteboard or blackboard, whatever.
00:25:21.680 --> 00:25:23.839
You have trouble reading the signs if you're driving.
00:25:23.839 --> 00:25:28.720
So you need corrective glasses to help you see things far away in space.
00:25:28.720 --> 00:25:34.079
If you're visually nearsighted, what if you're temporally or time nearsighted?
00:25:34.079 --> 00:25:38.480
It means you can see things and experience things near in time to you.
00:25:38.480 --> 00:25:49.119
Immediate payoffs, but you're not motivated, you're not paying attention to, and you're not, your behavior isn't motivated by things that are far away in time from you.
00:25:49.119 --> 00:25:52.799
It's harder to get to future goals and payoffs.
00:25:52.799 --> 00:25:55.279
That's what impulsive is.
00:25:55.279 --> 00:25:58.000
You care about the immediate gratification, right?
00:25:58.000 --> 00:26:05.599
So if we think about they have a sort of time blindness or nearsightedness, then I say to kids, you need organizational eyeglasses.
00:26:05.599 --> 00:26:06.480
Right?
00:26:06.480 --> 00:26:09.519
And so we put these visual structures in place.
00:26:09.519 --> 00:26:13.680
So that helps sometimes kids and teachers have a oh, that does make sense.
00:26:13.680 --> 00:26:19.759
That's why this kid does need this, or the kid going, okay, it's kind of a pain, it makes me different.
00:26:19.759 --> 00:26:25.200
I don't want the, you know, to be nagged, but okay, I can see how I need to maybe put on my eyeglasses.
00:26:25.200 --> 00:26:38.960
I tell the kids, yeah, if you want to make life easier for yourself, put on some ADHD eyeglasses, some time organizers for you to make life a little easier so you can get on to your strengths better.
00:26:38.960 --> 00:26:42.400
So, all right, that's a little riff that I like to get in there.
00:26:42.720 --> 00:26:43.359
I love that.
00:26:43.359 --> 00:26:50.720
That's so important to think about in that way, and it really makes a lot of sense when it comes to being able to support our kiddos.
00:26:50.720 --> 00:26:55.039
So this has been such an important conversation.
00:26:55.039 --> 00:27:01.759
ADHD is complex, but with understanding and support, kids and teens can absolutely thrive.
00:27:01.759 --> 00:27:02.240
Dr.
00:27:02.240 --> 00:27:04.720
Montminy, thank you for sharing your insight.
00:27:04.720 --> 00:27:08.000
Before we close out, is there anything else you would like to add?
00:27:08.400 --> 00:27:10.319
Yeah, thanks again for having me.
00:27:10.480 --> 00:27:11.599
always important here.
00:27:11.599 --> 00:27:20.240
I guess one thing we didn't touch on, I'd be remiss if I didn't say medication is often a very important part of the treatment plan.
00:27:20.240 --> 00:27:33.119
Again, we're talking about some neurological, biochemical deficiencies that make some of these things we've talked about, sustaining attention, inhibiting impulses more difficult for a person with ADHD than not.
00:27:33.119 --> 00:27:41.759
And yes, there are some medications that are tailored to help address that part of the brain that can help make life a little easier.
00:27:41.759 --> 00:27:51.599
It's not a cure, it's not a magic wand, but absolutely you want to get to the pediatrician or talk to others about the pros and cons of considering medications.
00:27:51.599 --> 00:28:00.319
And I think it's really important to consider that seriously and often have seen kids really, really benefit from that as well.
00:28:00.319 --> 00:28:08.400
It helps them use our behavioral structures, our emotion coaching skills better and gets them to a more even playing field.
00:28:08.400 --> 00:28:11.680
So it's uh it's well worth considering that as well.
00:28:12.079 --> 00:28:12.960
Thank you so much.
00:28:12.960 --> 00:28:14.960
Such an important part to add.
00:28:14.960 --> 00:28:22.480
So ADHD is not a deficit of intelligence or potential, it's a difference in how our brain works.
00:28:22.480 --> 00:28:28.240
With understanding, support, and the right tools, kids with ADHD can absolutely thrive.
00:28:28.240 --> 00:28:32.319
And thank you to everyone listening to Bripples of Resilience and to Dr.
00:28:32.319 --> 00:28:34.880
Peter Mutmini for joining us today.
00:28:34.880 --> 00:28:45.519
This podcast is brought to you by Janna Murray Foundation, where we're dedicated to opening minds and saving lives through conversations that matter, and by a mindful village, where Dr.
00:28:45.519 --> 00:28:50.400
Peter Montminy provides holistic mental health care for kids and their caregivers.
00:28:50.400 --> 00:28:56.160
If you found this episode helpful, consider sharing it with a friend, caregiver, or educator.
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Until next time, take care of yourselves and each other.